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Integumentary System

Skin, Hair, Nails.

Review A & P
Layers of skin
Epidermis Dermis Subcutaneous tissue Glands of the skin

Hair Nails

Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.)

Anatomy of Nails
Image p 275

What are the major functions of the integumentary system?


1. *Prevents penetration: barrier 2. *Protection: physical, chemical and thermal

3. Regulation: temperature
4. Perception: sensory organ (pain, touch, pressure, temperature)

Other functions
Identification Communication Wound repair Absorption/excretion Production of vitamin D

Functions of Hair
Provides ..
Warmth Protection Sensation to underlying structures

Functions of Nails
Provides .
Protection to distal surfaces Can be used for self-protection

Subjective Data

Health history (blue pages)

Integumentary SystemHealth History


any past skin problems and their management skin colour changes temperature changes texture changes sweating any masses including warts or moles (nevi)

Integumentary SystemHealth History


changes in masses, warts, nevi also, cosmetic concerns and physical discomfort rashes or eruptions changes in hair texture or oiliness, hair loss, dandruff, hair bleaching, dyeing management of any problems with hair or scalp medications

Integumentary SystemHealth History


complaints of tenderness, flakiness, itchiness, lumps, sores on scalp, bleeding problems with nails including breaking, ingrown nails, paronyhia (hangnails), nail biting Self-care behaviours

Describe how to assess the clients integumentary system by inspection and palpation?
Inspection and Palpation

1.How will you prepare the environment? 2. How will you prepare the client? 3.How will you protect the clients privacy? *4. What equipment is needed? (Direct lighting, small ruler, penlight, gloves)

Objective Data

What are the general characteristics of the skin that should always be noted?
Inspection and Palpation of the skin

Inspect Colour
General pigmentation: freckles, mole (nevus), birthmarks.

Widespread colour changes: pallor, erythema, cyanosis, jaundice.

Palpate Temperature
Should be warm & equal bilaterally Hypothermia: immobilized extremity, cast, IV (normal) Hyperthermia: fever, exercise, trauma, infection or sunburn.

Palpate Moisture
Normal perspiration Diaphoresis Dehydration in mucous membranes

Palpate Texture
Smooth and firm Even texture

Palpate Thickness
Epidermis is thin over most of the body Calluses over palms and soles

Palpate Edema
Not normally present Scale from 1+ to 4+ Most evident on feet, ankles, and sacral areas Note extent and location

Palpate Mobility and Turgor


Mobility is the skins ease of rising Turgor is its ability to return to place promptly. Pinch up on skin and let go (ant. Chest under clavicle)

Inspect Vascularity or Bruising


Cherry (senile) angiomas Ecchymosis (bruising): consistent with traumas of life. Tattoos: document location on chart.

Inspect Lesions
1. 2. 3. 4. 5. Colour Elevation Pattern or shape (p.250-251) Size in cm (avoid quarter or pea) Location and distribution on bodye.g. generalized or localized 6. Exudate, note colour and odor
(See OH for images on p 290 -293)

Danger Signs.ABCDE
Asymmetry of a pigmented lesion Border irregularity Colour variation Diameter greater than 6 mm Elevation and enlargement(any change)

How do you examine a lesion?


Palpate, wear gloves Roll nodule between thumb and forefinger to assess depth Does it blanche with pressure or when stretched?

Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.252

Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.253

Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.254

What are the criteria used in assessing the hair and scalp?
Inspection and Palpation of the hair and scalp

Inspect Colour
Pale blonde to total black graying

Palpate Texture
Fine or thick Straight, curly or kinky shiny

Palpate Distribution
Fine hair coats the body Coarse hair at the eyebrows, eyelashes and scalp Puberty: hair to face (male), axillae and pubic region

Inspect Lesions
Clean and free from lesions No nits or head lice Seborrhea (dandruff) is normal

What criteria are used in assessing nails?


Inspection and Palpation of the nails

Inspect Shape and contour


Normally slightly curved or flat Nail folds smooth and rounded Nail edges are smooth, rounded and clean. Normal nail angle- 160 degrees Clubbing: occurs with long standing hypoxia - emphysema and chronic bronchitis

Inspect Consistency
Smooth and regular, not brittle or splitting Thickness is uniform throughout nail Nail firmly attached to nail bed

Inspect & Palpate Colour


Nail bed is pink Brownish-black linear bands or streaks along the nail edge in dark-skinned individuals White hairline linear markings usual as well. Capillary refill: colour return is instant or within a few seconds. A sluggish return takes longer than 1 to 2 seconds.